The effect of reaccreditation on general practice in New Zealand

Abstract

The Reaccreditation Programme of the Royal New Zealand College of General Practitioners (RNZCGP) became compulsory for all members in 1994. Ongoing reaccreditation of medical specialists is a new, but rapidly growing trend on which little research has been done. The aim of this thesis is to investigate the effects of reaccreditation on general practice in New Zealand in the first three years of the programme. The history and current status of reaccreditation programmes throughout the world is summarised. The requirements of the RNZCGP Reaccreditation Programme are described and contrasted with the requirements of other programmes. A basic assumption of the Reaccreditation Programme that general practitioners can accurately identify their own areas of deficiency, is tested and found to be incorrect. A very low correlation between general practitioners' self assessments of knowledge on a given topic, and their results on a written objective test was found. The attitudes of general practitioners to the Reaccreditation programme, both shortly before it began and three years post-implementation are tested using a validated semantic differential questionnaire. Initial acceptance was reasonably high, but this decreased with time. Qualitative and quantitative studies of the ways in which general practitioners have altered their educational activities because of the programme showed improvements in the quality of the activities selected, but little increase in overall time spent. Analysis of the effects of the compulsory audit aspect of the Reaccreditation Programme showed that this activity has resulted in significant improvements to patient care. The effects of the programme on general practice are analysed in the light of current change theories and finally recommendations are made regarding the possible future development of the RNZCGP Reaccreditation Programme.